Posttransplantation: Emerging and future therapies

Liver transplantation in patients infected with hepatitis B virus (HBV) com monly results in reinfection that, if untreated, often compromises the viab ility of the allograft and negatively influences survival. Posttransplant t reatment with hepatitis B immune globulin (HBIG) is now the standard of car e, but patients appear to require lifelong treatment to prevent reinfection . In the past several years, new management strategies in patients with HBV have been developed, with an aim to decrease HBV-DNA replication before tr ansplantation. Such an approach should increase the success of transplantat ion by decreasing the risk of reinfection and thus preventing recurrent dis ease posttransplantation. Nucleoside analogues, either alone or in conjunct ion with HBIG, are currently in use and are being studied in clinical trial s as a means of preventing viral recurrence. Ganciclovir, famciclovir, and lamivudine all have demonstrated efficacy: although they vary in terms of e ffectiveness. Resistance may develop with the rise of these agents and lead s to reinfection by the mutant virus. Combination therapy may minimize the risk of viral mutation. Research continues to search for move effective may s to prevent and, if necessary, treat viral recurrence in patients undergoi ng liver transplantation for HBV.